Misdiagnosis of cellulitis common

NATIONAL HARBOR, Md. — Other conditions being misdiagnosed as cellulitis contributes to high health care costs and a significant number of unnecessary hospital admissions, according to a speaker at Hospital Medicine 2019.

“We know that cellulitis is a big problem,” Misha Rosenbach, MD, associate professor of dermatology and internal medicine and director of inpatient dermatology at the University of Pennsylvania, said during a presentation. “It’s a fairly common cause of admission. It’s also a common cause of 30-day readmission. Many of those causes of 30-day readmissions were probably indicative of cases that were not actually true cases of cellulitis initially or were cellulitis with another component that was incompletely addressed at the first hospitalization.”

Because there is no “gold standard” that hospitalists can use to diagnose cellulitis, approximately 30% of presumed cases of cellulitis are misdiagnosed, according to Rosenbach.

The overall burden to the health care system could potentially reach an estimated $195 million to $515 million in unnecessary spending, as well as more than 9,000 nosocomial infections.

Some examples of “mimickers” that are often mistaken for cellulitis include allergic contact dermatitis, psoriasis, shingles and Lyme disease, according to Rosenbach.

Rosenbach provided hospitalists with some guidelines for distinguishing between cellulitis and pseudocellulitis.

“If it’s bilateral [and the patient has] no fever or elevated white blood cell count, or if it’s not acute and fails to improve quickly, you should rethink whether it’s cellulitis and think about some of these other mimickers,” Rosenbach said. – by Melissa J. Webb

Reference:
Rosenbach M. Inpatient dermatology: Exam pearls for the hospitalist. Presented at: Hospital Medicine 2019. March 25-27; National Harbor, Md.

Disclosures: Rosenbach reports no relevant financial disclosures.